Does carvedilol (Carvedilol) have the same effect on heart rate as metoprolol (Metoprolol)?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: April 7, 2025 • View editorial policy

From the Guidelines

No, carvedilol and metoprolol do not have exactly the same effect on heart rate. While both medications are beta-blockers used to treat conditions like hypertension and heart failure, carvedilol has less pronounced heart rate reduction compared to metoprolol. This difference occurs because carvedilol is a non-selective beta-blocker that also blocks alpha-1 receptors, while metoprolol is a selective beta-1 blocker. Metoprolol primarily targets beta-1 receptors in the heart, resulting in more significant heart rate reduction. Carvedilol's additional alpha-blocking properties cause vasodilation, which can trigger reflex tachycardia that partially counteracts its heart rate-lowering effects.

Key Differences

  • Carvedilol is a non-selective beta-blocker with alpha-1 blocking properties, while metoprolol is a selective beta-1 blocker.
  • Metoprolol has a more significant heart rate reduction effect due to its selective beta-1 blocking action.
  • Carvedilol's alpha-blocking properties can cause vasodilation, leading to reflex tachycardia, which may partially counteract its heart rate-lowering effects.

Clinical Implications

  • Patients who need more substantial heart rate control, such as those with atrial fibrillation, may benefit more from metoprolol.
  • Carvedilol may be preferred in patients with heart failure who need the additional vasodilatory effects but for whom excessive heart rate reduction might be problematic.

Evidence

The Carvedilol or Metoprolol European Trial (COMET) demonstrated a 17% greater mortality reduction in favor of carvedilol compared to metoprolol tartrate 1. However, the evidence base for beta-blockers in heart failure has been established only for certain beta-blockers, including bisoprolol, metoprolol succinate, carvedilol, and nebivolol 2. The choice of beta-blocker should be based on individual patient characteristics and the specific clinical context.

From the FDA Drug Label

Both digitalis glycosides and β-blockers slow atrioventricular conduction and decrease heart rate. Carvedilol Tablet has no intrinsic sympathomimetic activity. β-adrenoreceptor blocking activity has been demonstrated in animal and human studies showing that Carvedilol Tablet (1) reduces cardiac output in normal subjects; (2) reduces exercise- and/or isoproterenol-induced tachycardia; and (3) reduces reflex orthostatic tachycardia.

The FDA drug label does not answer the question about whether carvedilol has the same effect on heart rate as metoprolol. [3] [4]

From the Research

Comparison of Carvedilol and Metoprolol Effects on Heart Rate

  • The effects of carvedilol and metoprolol on heart rate have been compared in several studies 5, 6, 7.
  • A study published in the European journal of heart failure in 2001 found that metoprolol tended to decrease heart rate during exercise to a greater extent than carvedilol, while at rest, increasing doses of metoprolol caused decreasing heart rates, whereas increasing doses of carvedilol caused increasing heart rates 5.
  • Another study published in the same journal in 2005 found that both metoprolol and carvedilol produced a fall in average 24-h heart rate from baseline at 12 weeks and at 1 year, with similar effects on 24-h heart rate 6.
  • A study published in the Journal of cardiovascular pharmacology and therapeutics in 2008 found that despite similar peak exercise norepinephrine levels, heart rate at peak exercise was higher in subjects receiving carvedilol than those receiving metoprolol XL 7.

Differential Effects on Heart Rate

  • The differential effects of carvedilol and metoprolol on heart rate may be due to their different mechanisms of action, with carvedilol having additional alpha-blocking effects 5.
  • The alpha-blocking effects of carvedilol may cause a reflex increase in sympathetic drive, leading to an increase in heart rate at rest 5.
  • The beta-blocking effects of metoprolol, on the other hand, may cause a decrease in heart rate at rest and during exercise 5.

Clinical Implications

  • The choice of beta-blocker, either metoprolol or carvedilol, may depend on individual patient characteristics and clinical conditions 8, 9.
  • A study published in The American journal of cardiology in 2021 found that overall survival after acute MI was similar for patients treated with metoprolol or carvedilol, but may be superior for carvedilol in patients with left ventricular ejection fraction ≤40% 9.

References

5
Research

Differing beta-blocking effects of carvedilol and metoprolol.

European journal of heart failure, 2001

8
Research

Beta-blockers and heart failure.

Indian heart journal, 2010

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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